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Speaking of weight: how patients and primary care clinicians initiate weight loss counseling

Authors
Journal
Preventive Medicine
0091-7435
Publisher
Elsevier
Publication Date
Volume
38
Issue
6
Identifiers
DOI: 10.1016/j.ypmed.2004.01.001
Keywords
  • Obesity
  • Primary Health Care
  • Counseling
Disciplines
  • Communication
  • Mathematics
  • Medicine

Abstract

Abstract Background. Obesity is epidemic in the US and other industrialized countries and contributes significantly to population morbidity and mortality. Primary care physicians see a substantial portion of the obese population, yet rarely counsel patients to lose weight. Methods. Descriptive field notes of outpatient visits collected as part of a multimethod comparative case study were used to study patterns of physician–patient communication around weight control in 633 encounters in family practices in a Midwestern state. Results. Sixty-eight percent of adults and 35% of children were overweight. Excess weight was mentioned in 17% of encounters with overweight patients, while weight loss counseling occurred with 11% of overweight adults and 8% of overweight children. In weight loss counseling encounters, patients formulated weight as a problem by making it a reason for visit or explicitly or implicitly asking for help with weight loss. Clinicians did so by framing weight as a medical problem in itself or as an exacerbating factor for another medical problem. Conclusions. Strategies that increase the likelihood of patients identifying weight as a problem, or that provide clinicians with a way to “medicalize” the patient's obesity, are likely to increase the frequency of weight loss counseling in primary care visits.

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